Provider First Line Business Practice Location Address:
3901 BEAUBIEN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR NEUROSURGERY CLINIC
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-993-4490
Provider Business Practice Location Address Fax Number:
313-745-7222
Provider Enumeration Date:
12/18/2007